Arizona Peace Officer Standards and Training Board2643 E. University Drive, Phoenix, AZ 85034 Telephone (602) 223-2514 Fax (602) 244-0477

SME INSTRUCTORAPPLICATION

To the SME Instructor Applicant: This form shall be completed by each individual nominated as a member of an AZ POST Subject Matter Expert (SME) Instructor in the following areas: l General Instructor l Defensive Tactics / Impact Weapons l Firearms l Physical Conditioning l Tactical Driving l High Risk Vehicles Stops l First Aid The applicant must have the endorsement of his/her agency head (academy commander if being nominated to represent an academy). Please complete all blocks with the desired information. Use "NA" if appropriate. Completed applications shall be submitted to AZ POST, along with a recent resume. The applicant will be notified in writing of his/her status.

Last Name: First Name: MI: Last 4 of Social Security #:

APPLICANT

Phone Number:

Address:Mailing address:

Basic Instructor Certifications Held (check all that apply)

Agency / Academy

Email address:

(if different)

AZ POST General Instructor

AZ POST Defensive Tactics Instructor

PPCT Instructor

AZ POST Impact Weapons Instructor

Monadnock PR 24 Instructor

AZ POST Firearms Instructors

NRA FIrearms Instructor

NRA Semi-Auto Instructor

Firearms SImulator Instructor

AZ POST High Risk Vehicle Stop Instructor

AZ POST Tactical Driver Instructor.

AZ POST Physical Fitness Instructor

Cooper's Institute Fitness Instructor

American Red Cross First Aid Instructor

American Red Cross CPR Instructor

American Heart Association CPR Instructor

INSTRUCTOR APPLICATIONDate Received by AZ POST

Date Referred to SME Group

Date of Final Action

Staff Assigned

SME Committee Chairman

AZ POST Training Projects Manager (type or print)

SignatureApproved

Disapproved

AZ POST Form SME2 (May 12) Page 1 of 2

Other (Please specify)

SME Instructor Applied for (check only one)

AZ POST General Instructor

AZ POST Defensive Tactics

AZ POST Tactical Driving

AZ POST Firearms

AZ POST Physical Fitness

AZ POST High Risk Stops

AZ POST First Aid

AZ POST Form SME2 (May 12) Page 2 of 2

AGENCY / ACADEMY ENDORSEMENT

As the chief executive officer or designee of the aforementioned agency or academy, I certify that the applicant has requested and been granted permission to apply to be an AZ POST SME Instructor. I understand that if selected and approved as an SME Instructor, the applicant may be requested to assist in future AZ POST instructor schools as may be appropriate. This individual is recommended as someone capable of functioning in the capacity of a subject matter expert.

Name (type or print) Title

Signature Date_________________________________________________________ ____________________________________

SME COMMITTEE EVALUATION

Instructions to SME Evaluator: A member of the applicable SME committee shall oversee this portion of the certification process and evaluate the applicant as indicated below. The SME evaluator shall record all scores and critiques on this form and attach original copies of any written and/or practical examinations. Please us "NA" if appropriate. Completed forms shall be returned to AZ POST for final review and approval.

1. SME Bio / Resume Attached to application ?

2. Written Comments ... Written Test Score: % Pass Fail NA

Practical Examination: Pass Fail NA

Classroom Instruction: Pass Fail NA

AZ POST SME Chairperson (type or print) Date Returned to AZ POST

Signature Recommended as SME Not Recommended

Yes (Continue to #2)

No (Return to AZ POST)3. Does Applicant meet minimum qualifications ?

Yes No

4. Written Test Comments:

5. Practical Examination Comments:

6. Classroom Instruction Comments:

Please include the following with your Resume: Name Address Personal Information (rank) Hire Date Years of Service Previous Law Enforcement Service Certifications Instructor Certifications Instructor Experience Any additional information you want the SME Chairperson and Committee to know.